RPL (9510-103)LICENSED CON'
I hereby affirm that I am licensed un
Section 7000) of Division 3 of the
License is in full force and effect.
License # �, I
,DateSionatureofCo
:TOR DECLARATION{, f"'.
.•
g with
of Chapter 9 (commencing
ness and Professionals Coddle, and. my
Lib C. -a- n.,._ ` J31197
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason:-
( ) I, as, owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals Code).
( ) I am exempt under Section , B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
( ) I have and:will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
() I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier ,,„ ., Policy No.
(This sectI6WAWcfr16t "e completed if the permit valuatio `is for $100.00 or less).
() I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date:,TApplicanti:�ir
Warning: Failure to secure Workers' Compensation coverage is unlawfufand shall
subject an employer to criminal penalties and civil fines up to $100000, in
addition to the cost of. compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this application agrees to, & shall, indemnify
& hold harmless the City of Indian Wells, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of Issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify, that I have read this application and state that the above information is
correct.' I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon thl
above-mentioned property for,inspection p roses., �-- B
.nature (Owner/Agent) t r Tom. Date
i
A"'
BUILDING
PERMIT
PERMITi
�SAi!-lil:4 .
DATE :,to1.sAf9.,5
VALUATION �?!:D,d300.i1Ai
LOT
TRACT
JOB SITE ADDRESS
APN
441-.2$.5 MOUPffAiNLUMMS
OWNER
CONTRACTOR
MC;iIrI`f`YR laC3Ct,LS & SPAS
A4t"I.jS'€)ZCi.I i ,P.A�lN:tED COOT,
46301 OUi;�EL LANE
50445 MOUNrAfN SHADOWS Rd
LA.QU.IN'7A CA 92,253
LA QU1NTA CA 92253
(619):342.-3521. CB'L# 1945
DESIGNEWENGINEER
(619564.1849
-
t
USE OF PERM POOL .A.f``1 OR SPA
REAR. YARD SET Jk4LK.12EOUCTI.ON 7'o Y AP1'iZt3M PER S€3A-95.353.
FEE DESCRIPTION
FEES
POOL ANWOR SPA 13,000.00 LS
Ma.I4"ATED COST OF CONSTRUC T'IldN
133,(8'141 or!
P1*;.IidldU`I!` .FEE SU±V MA. Y
PLANT CHECK FFY 101-000-439-318 $93.60
CONSIMUC'LIO.N=FEE i01-000.41 -000 8144.04
MECHMICAL. FEE 101-000-421.000
E(.,:ECIRICAL FEE ', 10 t-00I?�4211dK)0 3dS.40=
PLtTMRING P13T, $27.00
SUB -TOTAL CON.S.rRUC" 1'TON AND :PLAN CHECK
$333.60
LESS PREPAID FLIES
$0.90
r
Q a TOT'.AI, PE1<iMrf FEES DWS 'NOW
$333.60
NOVO 6 1995 TOTAL PRORTT PERMITFEES333.60
..:..
RECEIPT
DATE"'
By
DATE RNALED,
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
oig
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test —
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)